Internal carotid artery

Vertebro-basilar artery

∎Cerebral Arterial Circle/Circle of Willis: the origin of the anterior cerebral arteries on both sides, the ends of the internal carotid arteries on both sides, the posterior cerebral arteries on both sides, the anterior and posterior communicating arteries; surrounds the optic chiasm and interpeduncular fossa at the base of the brain, and is the connection between the base of the brain and the inside of the neck The important structures of the arterial system and the vertebral-basilar system enable both sides of the cerebral hemisphere and the front and back of one cerebral hemisphere to have adequate blood supply to the brain.

Superficial cerebral veins: superior cerebral vein, middle cerebral vein, inferior cerebral vein

Deep cerebral veins: internal cerebral veins, basal veins, great cerebral veins (veins of Galen)

Brain tissue blood flow accounts for 20% of cardiac output, and oxygen consumption accounts for 20-30% of the whole body; neurons are the least tolerant of hypoxia, and vascular endothelial cells are the most tolerant of hypoxia; the cerebral neocortex (layers 3, 5, and 6 ), hippocampal CA1 pyramidal cells and cerebellar Purkinje cells are most sensitive to hypoxia

Characteristics of cerebral blood circulation

Ischemic cerebrovascular disease: TIA, cerebral infarction (cerebral thrombosis, cerebral embolism)

Hemorrhagic cerebrovascular disease: cerebral hemorrhage, subarachnoid hemorrhage

Venous CVD: venous sinus thrombosis, deep cerebral vein thrombosis

OCSP typing, TOAST typing

Age of onset: For those over 50 years old, arteriosclerosis and hypertension are first considered; in middle-aged patients, cerebral aneurysm is first considered; in pediatric patients, cerebral vascular malformation is first considered

Pattern of onset: Embolic cerebrovascular disease is more common in seconds; cerebral hemorrhage is more common in minutes to hours; thrombotic disease is more common in hours to days

Middle cerebral artery (MCA) TIA: monoparesis/hemiparesis of the contralateral limb (most common), facial palsy/lingual paralysis (rare), may be accompanied by sensory impairment (numbness and abnormal sensation in many parts of the limbs, rarely complete loss), Lateral homonymous hemianopia (rare); involvement of the dominant hemisphere may cause aphasia and apraxia, and involvement of the non-dominant hemisphere may cause body image disorder

Anterior cerebral artery (ACA) TIA: personality, emotional disorder, contralateral lower limb weakness

Internal carotid artery (ICA) TIA: ophthalmic artery crossed palsy (amaurosis fugax/blindness in one eye on the affected side, hemiplegia/sensory impairment on the contralateral side), Horner crossed palsy (Horner's sign on the affected side, contralateral hemiplegia)

Typical manifestations: transient cranial nerve palsy with contralateral limb paralysis/sensory impairment

Common manifestations: dizziness, balance disorder, abnormal eye movement, visual field loss and diplopia (but rarely tinnitus at the same time); there may be slurred speech, ataxia of one limb, blurred vision of both eyes, hoarseness, hiccups and vomiting

∎ Drop attack: Often when turning/raising the head rapidly, the lower limbs suddenly lose muscle tone and fall, with unconsciousness and often standing up on their own very quickly; caused by ischemia of the reticular structure in the lower part of the brainstem

Antiplatelet therapy: especially non-cardioembolic TIA

∎Anticoagulant treatment: Especially for cardioembolic TIA with frequent attacks, severe attacks, and gradually worsening symptoms; generally, oral anticoagulation with warfarin is changed to warfarin after short-term use of heparin.

Volume expansion therapy: especially hemodynamic TIA

∎ Thrombolytic therapy: especially if ischemic stroke is suspected

Others: such as traditional Chinese medicine treatment